Creating an Informatics Profile in Minnesota to Assess Readiness for Interoperability and Use of Standards PHIN 2008 Conference Atlanta, August 28, 2008 Perspectives in Interoperability Session Marty LaVenture, PhD, MPH Priya Rajamani, PhD Jennifer Ellsworth, MPH Minnesota Department of Health

Topics E-Health Context in Minnesota Creating an Informatics Profile Initial Findings Recommendations for State Health Departments

Minnesota e-Health Initiative Vision “… accelerate the adoption and effective use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs, and enable individuals and communities to make the best possible health decisions.” This vision for the MN e-Health Imitative was created in 2004 and has guided us ever since: “to accelerate the adoption and use of health information technology to: Improve healthcare quality; Increase patient safety; Reduce health costs; and Enable individuals and communities to make the best possible decisions. Note the focus on both individuals and communities. We are committed to keeping a strong consumer and public health focus to our initiative in Minnesota. This vision is closely aligned with the goals of health care reform and transformation in that they both focus on increasing quality, safety and access for the benefit of us as purchasers and consumers of health care. Source: e-Health Initiative Report to the MN Legislature, January 2004

2007/08 Minnesota Legislative Action State mandate that all healthcare providers have interoperable electronic health records by 2015 Mandate applies to public health both as a provider of care and exchange partner of electronic health information Establish uniform health data standards by 2009 Develop a statewide plan to meet the 2015 mandate

Minnesota’s Statewide Plan Components of the Plan Part 1: Background Part 2: Minnesota Model for EHR Adoption Part 3: Emerging Issues Part 4: Recommendations Appendices Guide 1: Common Barriers Guide 2: MN. e-Health Standards Special Interest Area: # 1 Long Term Care # 2 Public Health

Recommendations for Public Health Collaboratively define the specifications Develop business and resource plans Ensure workforce informatics competency Identify and seek needed resources For public health, the recommendations are similar: Collaboratively define the specifications for making public health information systems more standards-based and interoperable Develop business and resource plans for modernizing information systems, making them both more integrated and interoperable. Identify and seek needed resources Ensure that staff have the informatics knowledge and skill they need to improve the design and use of the information systems

Purpose of Informatics Profile To identify systems of priority interest To understand the exchange needs / partners To assess readiness for interoperability and use of standards To identify barriers and resources needed to increase levels of interoperability and integration

Conceptual Model MDH Informatics Profile Minnesota Department of Health Information Systems Includes infrastructure, data sets and applications Data Partners (Data Collection by MDH) Data Partners (Data Recipients from MDH) Applications Data Sets Collecting Data Sending Data Cross cutting issues across all components Standards Electronic Exchange Capabilities

Informatics Profile Inclusion Criteria Approx 83 datasets which hold person name level information Approximatelly 60+ data sets which fulfill ehealth and common ground criteria 9

MDH Systems of Priority/Interest by Type of Program Minnesota Department of Health Systems # Acute disease 8 Maternal and child health 4 Chronic disease 3 Injury 2 Vital statistics 1 Laboratory information management system Total 20 Many public health information systems of interest MDH is collecting data on various public health systems (related to standards, exchange capabilities and needs, interoperability, and modernization plans for the future) Close to completion of collection at MDH, next steps will include local health departments and Department of Human Services Current total is 31 various systems of interest 10

Informatics Profile Questionnaire Domains Core information about system Number of clients/individuals and transactions/year Type of information exchanged Exchange Partners Exchange methods Standards – exchange, representation Integration interest Interoperability Readiness for exchange Barriers/resources Approximately 40 questions in the survey 11

Interoperability of Minnesota’s Public Health Information Systems June 2008 MDH System Interoperability Level Current / Capability Level 1 Non electronic data (paper, mail, phone) 4 Level 2 Machine transportable data (fax, e-mail, unindexed documents) Level 3 Includes web based interface. Human action required. FTP file uploads. 8 Level 4 No human action required. Machine to machine exchange of data (structured messages, standardized content) including HL7 messages 4* * In process, will increase by 1, in Fall 2008. Total = 20 We categorized interoperability levels on current use and planned/capability levels for the systems in 4 incremental changes in interoperability based on the National Alliance for Health Information Technology definition. This information was self-reported for each of the systems based on current use of their system (including current exchange partners) and does not represent interoperability with future/ideal exchange partners – as those numbers would be lower. Level 4 - Systems currently are / will be so in next 3 years are WIC, BLIS, MIIC, MCSS Level 3 – Refugee Health, STD Infonet, eHARS, Trauma registry, TBI, stroke registry , MEDSS, Vital Records, Based on current collection on 19 MDH systems, we know that: * There is great variability at MDH as it relates to current system interoperability levels – Some systems are currently operating at a high interoperability level or have plans in the near future (based on current modernization plans), but many systems are far from achieving a level 4 interoperability. This is based on a number of factors: 1) Limitations of exchange capabilities of external exchange partners 2) Resource issues (funding, staff/time) 3) Lack of an agency-wide coordinated interoperability plan and/or understanding of what needs to be done But in reality we have a long ways to go, especially when we what needs to happen to have interoperability with EHRs (in cases where it is appropriate to do so). Interoperability levels are based on the National Alliance for Health Information Technology definition and based on self-assessment of current system use including current exchange partners. The numbers do not reflect future or desired exchange partners/sources (e.g., EHRs). 12

Informatics Profile – Initial Findings High variability of interoperability levels Not all functions have equal exchange capability Not all stakeholders have capability Strong desire (100%) want to improve exchange capability with stakeholders Many challenges to improving level of interoperability Capabilities of external partners Resources (funding, staff, skill set) Need for a agency-wide coordinated interoperability plan 13

Utilization of Standards For exchange and representation of data Standards for exchange of data HL7 standards Current use: 4 of 20 (20%) Future: 6 of 20 (30%) No plans yet: 10 of 20 (50%) PHIN-MS transport Standards for representation of data 14 of 20 systems (70%): Use national standards for certain fields for data representation 4 systems (20%): only use CDC provided codes 2 systems (10%): No standards/codes HL7 & PHIN-MS currently used mainly for lab data (LARS) Variability extend to this set as well. ICD – 9 and 10 , E.g., immunization registry (CPT, CVX and MVX codes) & cancer registry [ICD-9-CM, CPT, SNOMED-CT and ICD-O (for oncology)] 14

Desired Exchange Partners (Through Better Integration or interoperability with other systems) MDH Systems N = 20 This graphs denotes the desired exchange partners (either through better integration or interoperability with other systems). There is a great desire for better interoperability with private providers and hospital, especially through their EHR systems. In addition, there is a great interest in better integration within MDH on related systems (e.g., better integrated child health systems). MDH = 12 out of 20 systems mentioned wanting to be able to exchange information internally. Of those 12 systems: 5 systems want to be able to exchange with MEDSS 4 systems want to be able to exchange with Vital Statistics 3 systems want to be able to exchange with STD InfoNet 3 systems want to be able to exchange with eHARS 3 systems want to be able to exchange with STD MIS 2 systems want to be able to exchange with WIC 2 systems want to be able to exchange with BLIS (blood lead) 2 systems want to be able to exchange with MIIC 1 system wants to be able to exchange with MCHSN EHDI 1 system wants to be able to exchange with MCSS Type of Organization / System

Barriers to Information Exchange MDH Systems N = 20 “Other” category includes: - Lack of unique personal identifier across systems - Limitations in capabilities of exchange partners (e.g., local public health, providers) - Lack of interoperability, difficulty coordinating with entities we exchange with, many silo systems – not connected - Benefits of enhanced systems are hard to communicate/explain (in some areas cost will go up, in some areas cost will go down, but exact benefit may not come to MDH, e.g., LIMS) - Political constraints 17 out of 20 programs (85%) mentioned lack of resources as a barrier to efficient exchange of information Perceived Barriers

Barriers – Other Observations Limitations in capabilities of exchange partners (e.g., local public health, providers) Lack of interoperability and difficulty coordinating with internal and external exchange partners Benefits of enhanced systems are difficult to communicate e.g., in some areas cost will go up, in some areas cost will go down, but exact benefit may not come to a specific system Political constraints Lack of unique personal identifier across systems 17

Resources Needed for Exchange Perceived Resources Needed MDH Systems N = 20 “Other” category includes: - Agency wide strategic plan for interoperability, coordinated unified approach, plan for implementing PHIN-MS - Master client index - Political support, political will, and agency commitment from the top - Getting providers to have the capability to send HL7 messages - Political clarifications on who has access to data and what’s permissions to disclose - Need for adequate IT staff located within program Perceived Resources Needed

Conclusions and Implications for Public Health and Informatics An informatics profile is feasible & useful for: Strategic and tactical planning around interoperability Identify barriers and needs to achieving integration and interoperability. Increasing awareness for existing projects helping create opportunities for collaboration Identify needs related to informatics competencies' Assessing preparedness for integration (internal) and interoperability (external) for executive leadership and policy makers 19

Recommendations for Action Create Public Health and Informatics Assess the informatics status for integration and interoperability begin now if you have not done so use a profile or similar tool to help in your process If you have done an profile or similar, share your tools and findings Participate in efforts to improve the informatics methods, and tools that help us measure our informatics capacity Create an organizational focus for Informatics such as a center for health informatics to address interoperability and integration issues and provide agency wide coordination and community exchange partners (a focal point) Educate your self and others on public Health informatics Public health havs to be pat of this environment 20

Thank You! For more information: www.health.state.mn.us/ehealth Contact Information: Priya Rajamani 651-201-4119 Priya.Rajamani@state.mn.us Jennifer Ellsworth 651-201-3662 Jennifer.Ellsworth@state.mn.us For more information on the MN e-Health Initiative, here is our website, and here is my contact information for further questions. Thank you!